Pat says,

> Will this mom use a supplementer at the breast?  Cup or bottle feed??  The
> method of supplementation and then baby's subsequent weight gain would be
> what guides my gesstimation of amounts.  Sincerely, Pat in SNJ
>
>
My question about this was theoretical, and I was looking for evidence based
practice here, not the how to supplement.  I was trying to point out from a
scientific perspective that there are a number of ways of determining how
much supplement a baby needs according to kcal/kg body weight, but they all
seem to differ.  I'm not asking about a specific mom -- I am asking you
(collectively) to think about *how* you determine a minimum a baby who is FTT
should take per feeding.  Linda Smith has given her perspective on it based
on how much breastmilk is produced on average, and how much breastmilk a baby
takes in a 24 hour period -- on average.

So again, my question is:

Do you use a certain number of kcal/kg body weight to determine how much a a
baby needs (as noted in ILCA's publication on Evidence Based Practice for the
First 14 Days?).

Do you use a certain number of ounces per pound of body weight?  It ranges,
depending upon  who you read from 2 - 3 ounces/pound of body weight, with an
average being about 2.5, but that calculation then is different from either
the 108 kcal/kg, or the 120 kcal/kg.

I agree in theory with letting the baby take as much as they want.  I agree
in theory with using a tube system at the breast, but what I'm asking is how
you practice when you are determining the minimum amount of supplement a baby
should take at a feed -- or over the entire 24 hours.  Moms want/need to
know, and I'm trying to see if LCs in general are using some sort of evidence
based guidelines or flying by the seat of their collective britches in
determining what needs to be done in the case of a FTT infant.

Jan Barger, RN, MA, IBCLC -- Wheaton IL
Lactation Education Consultants
www.lactationeducationconsultants.com

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